Stretching for the Active Adult Woman

Stretching for the Active Adult Woman

By Ryann Roberts, DPT and Brooke Smith, DPT

It is hard enough to squeeze a daily exercise routine into your busy schedule.  You may think adding extra time with a before or after workout stretch is something you should just fit in when time permits.  The focus is on the exercise, not the stretch, right?  Wrong.

Stretching is just as important in your workout routine as the actual exercise.  Stretching increases flexibility, which in turn will help to increase your athletic performance and decrease your risk of injury.  For the active adult woman, the emphasis is on decreasing the risk of injury.  Understanding why stretching helps, and what stretches the active adult woman should perform, can help reduce and/or eliminate these injuries.

Stretching can help improve flexibility.  Flexibility may decrease your risk of injury by allowing your joints to move through their full range of motion.  For example, let’s say you are a 60 year old woman with tightness in her hips and ankles.  This tightness prevents your body from going through its full range of motion, which eventually can develop into tendonitis in your knee or lower back pain.  Properly stretching can increase the range of motion in your hips thereby reducing the risk of these micro traumas to your tendon that may lead to overload or injury.

Stretching also increases blood flow to the muscles, sending oxygen to the tendons and ligaments, essentially waking them up and preparing them for your workout.  

There are two types of stretching routines to perform – dynamic and static.  Dynamic stretching is stretching with movement, designed to propel the muscle into an extended range of motion.  This form of stretching prepares the body for physical exertion and performance.  Static stretching is used to stretch muscles while the body is at rest.  It is composed of various techniques that gradually lengthen a muscle to an elongated position (to the point of discomfort) and hold that position for 30 seconds to two minutes, two or three times per stretch. 30 seconds is the minimum duration to get the benefits of stretching, whereas two minutes is the maximum.

Always take the time to make sure you are stretching safely and effectively using proper technique.  Stretching incorrectly can actually do more harm than good.  Stretching cold muscles may cause injury, so we recommend warming up with some low intensity cardio for five minutes before beginning any stretching.  When stretching, do not bounce.  Bouncing can cause small tears in a muscle.  These tears cause scar tissue in the muscle that as it heals tightens the muscle even more, making you less flexible and more prone to increasing pain and causing injury.

To help, we have prepared a stretching routine to perform before and after you exercise.  

The following dynamic stretches are performed prior to exercise:

• Walking Lunge with Overhead Rotation
• Lateral Lunge
• Squats
• Walking Russian Kicks
• Arm Circles
• Posterior Deltoids Stretch
• Triceps Stretch

For a detailed description of these stretches, click here.

The following static stretches are performed after exercise:

• Standing Calf Stretch
• Hamstring Stretch
• Ilio-Tibial Band Stretching
• Standing Abductor Stretch
• Posterior Hip Stretch
• Low Lunge with Twist and Hip Flexor Stretch
• Standing Extensions
• Corner Stretch

For a detailed description of these stretches, click here.

It’s very easy to bypass stretching due to time constraints, but keep up with it.  The benefits of stretching are best when stretching is regular.  In some cases, you may need to approach stretching with caution. If you have a chronic condition or an injury, you may need to adjust your stretching techniques. For example, if you already have a strained muscle, stretching it may cause further harm.  

Lastly, stretching does not mean you cannot get injured.   Overuse injuries may still occur.  If you are feeling pain or are injured, please contact AZOPT for your FREE injury and/or performance screen with a licensed physical therapist.

A Newborn Baby's First Year - The Sound Development Parents Can Anticipate

Early Speech Sound Development

By Lanni Reisinger,SLP-CFY

Kids Place Pediatric Speech Therapist

Often times, parents of a newborn will wonder which sounds will first be heard by their baby and how to help produce these sounds.  From the time a newborn baby reaches three months and starts making their first sounds to when a baby is 12 months and forms their first word, parents can expect to hear a wide variety of noises and sounds. 

In this blog, I will address these milestones as well as the activities parents can perform to help their newborn progress.  Please note, these milestones are meant to be generalized.  There is no reason to be alarmed if your baby is slower at hitting certain milestones.  At the end of this article, I will list certain “red flag” milestones that may indicate your newborn needs to be evaluated.

At three months, your baby will begin to make sounds.  The first sounds you can expect to hear are vowel sounds when your baby is cooing and making pleasure sounds (“oo,” “ah,” “uh,” “oh,” “ee”).  At this time, your baby will also begin producing distinctive cries when they are hungry, wet, etc.  They will then begin producing strings of vowels with varying intonation.

When your baby begins babbling at four to six months, the first consonants they are likely to produce are “bilabial” sounds, produced with their lips (p, b, m).  These sounds are learned first because they are easily seen by your baby and fun to make.  This is also around the time you will first see your baby laugh.

At seven months, your baby will produce “reduplicated syllables” - repeating the same sounds over and over again (“babababa”).  Your baby will first produce these sounds in play, without any communicative intent.  You should then begin to notice your baby making sounds to gain attention.  Furthermore, around this time your baby will begin imitating more sounds and “talking” when others are talking.  You can prompt your baby to make sounds playing some basic games in which you take turns making sounds.

Here are some of my favorite games and songs for babies at this age:

• Peek-a-boo (hiding behind hands, blanket, napkin, etc.)
• Patty-cake
• This Little Piggy
• Head, Shoulders, Knees and Toes
• Row, Row, Row Your Boat
• Old MacDonald

It is also important to read with your baby.  It is not necessary to read every word in a book.  Simply talking about the pictures and pointing to things in the book will help.  You can prompt the production of sounds through making silly and nonsensical sounds while you play (“wee!” or “uh-oh!”).  You can also prompt your baby to imitate environmental sounds like animal sounds (“quack-quack!” and “moo!”) and transportation sounds (“vroom!” or “urch!”).

It is important to remember not only to prompt your baby to imitate your sounds, but imitate your baby’s productions as well.  Face-to-face time with your baby is important and using a “sing-song” tone with lots of rising and falling intonation will help your baby attend better to your sounds.  

By your baby’s first birthday, you can anticipate their first word, typically a word they use often (e.g., “mama,” or “hi”).

As a precaution, if your baby is not making any sounds by six months, or no consonant sounds (p, b, m) by ten months, an evaluation by a doctor is appropriate.  By 15 months, a baby should be saying their first word.  If this is not the case, an evaluation should be sought.

Why You Should See a Physical Therapist

Why You Should See a Physical Therapist

We thought it timely to remind readers about the importance of physical therapy. Here are 5 (of the many) reasons you should work with a physical therapist.

1. PTs are highly educated musculoskeletal specialists.

Physical therapists are required to complete extensive training — and to earn at least a master’s degree, if not a doctorate — before applying for state licensure. PT programs require coursework in anatomy, physiology and biomechanics, as well as multiple apprenticeships at physical therapy clinics. Even once a PT graduates and is licensed, the state requires continuing clinical education in order to maintain licensure.

2. PTs are able to treat the whole person, not just a single body part.

Because of their extensive musculoskeletal knowledge, PTs can evaluate your body as a whole. For example, knee pain could be related to weakness in your hip; back pain could be related to your general posture. This is why a physical therapist will do an evaluation of your entire body on your first visit, to assess not only where you feel pain, but the variety of factors that could cause it, and then create a specific treatment plan for your condition.

3. PTs not only do rehab after an injury, but also provide health and wellness programs.

As health care practitioners trained to help people recuperate from injury, physical therapists are uniquely prepared to help people live healthier lives. For example, many PTs offer nutrition and exercise programs through their clinics. The programs can be used to supplement the clinical treatment of a patient, like an arthritis sufferer who needs to lose weight to relieve joint pressure, or a client who is simply interested in living a healthier life. In the same vein, PT clinics offer such programs as wellness/fitness evaluations, strengthening and conditioning classes, and more.

4. PTs can design individualized programs to improve your health.

PTs have the knowledge to treat a variety of symptoms. The most common reason physical therapists are approached is pain relief, but they can also improve posture, body structure, circulation and function, as well as correct deformities and promote healing.

5. PTs often specialize in a variety of fields.

Chances are high that a physical therapist has specialized in a field of interest. While many work with specific types of athletes, others focus on general orthopedic concerns, or children, or seniors. Some PTs choose to do further study of particular health problems, work with cancer patients, help patients with Parkinson’s or multiple sclerosis maintain their strength or grow stronger, or rehabilitate back to independence.

As we continue to fight obesity and improve health throughout our country, it is clear that physical therapists are key partners in living healthier lives. Their training and clinical expertise are essential to maintaining strength and moving forward in all walks of life.

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For further reading:

Richman, Meryle. October 2011 is National Physical Therapy Month. Yorktown Patch, October 2, 2011.
Richman, Meryle. Living a healthier lifestyle. Yorktown Patch, August 30, 2011.
Slayback, Carrie Luger. My turn: Friends shine after physical therapy. Los Angeles Times, July 25, 2011.
Rachlin, Natalia. War wounds and tutus. Wall Street Journal, July 6, 2011.
About physical therapists. APTA, 2011.
Physical therapy eases burden of lymphedema. PennLive.com, November 2, 2010.
Hilton, Lisette. Aging frames: Baby Boomers visit PTs with musculoskeletal complaints. Today in PT, September 6, 2010.
Weinper, Michael. Physical therapists have what it takes: Meeting the health and fitness needs of Americans in challenging times. Impact, May 2010.
Rodriguez, Diana. Physical therapy after a stroke. Everyday Health, March 25, 2009.
Wiggin, Sally. Direct access can save patients time, money for physical therapy. WTAE Pittsburgh, March 9, 2009.

What is Torticollis?

What is Torticollis?

By Nichole Hagerty, DPT

Bringing home your precious newborn is an exciting yet nerve wrecking experience.  Parents will lay awake staring at their little girl, conscious of all their movements.  Her baby pictures will fill your walls, office spaces, and phones.  You will spend endless amounts of time hoping and praying she is perfect.

But then something seems off.  She only looks to the left.  In all of the pictures, her ear is constantly on her shoulder.  When she is placed on her stomach, she will continue to look left, but never right.  As the sleepless nights continue, you begin to notice her head shape is changing.  She begins to have a small flat spot because she is consistently looking left while keeping her ear tilted toward the left shoulder.

You become concerned.  Others may tell you not to worry, that your baby will grow out of it.  But your gut instinct is telling you something is wrong.  A pediatric physical therapy evaluation will determine if your child is affected by torticollis.

Torticollis, derived from the Latin words tortus for twisted and collum for neck, is the tightening of the sternocleidomastoid (SCM).  The SCM is a muscle that goes from the mastoid process of skull to the sternum and clavicle.  You have a right and left side SCM.  When the muscles work together, they flex the head forward.  However, when one is working alone, you bend your head sideways to the right and rotate your head to the left.  This is what occurs when a child has torticollis.  One of the muscles is tight, possibly due to positioning in the womb, birth trauma, or positioning after birth.

The incidence of Torticollis has been steadily increasing since 1997 with the introduction of the “Back to Sleep” campaign.  Not only is your child sleeping on her back, she is often times spending a lot of time in her car seat, her swing, her bouncer, and all of this wonderful baby holding equipment.  However, she is not spending enough time on her stomach.  She is not learning how her body works.  She has difficulty with being on her stomach and has not developed the neck extensors to lift her head that will allow her to explore her world.  Once these are developed, she needs to learn to play on her tummy without as much support, but still being supervised.  She needs to be able to reach and play with both of her hands equal. She needs to discover her body. The best way to do this is to spend time on her stomach.

Torticollis is typically treated with changes in positioning at home, as well as specific strengthening and stretching exercises.   A physical therapist can teach you simple stretching exercises to perform daily at home with your baby.  As time continues, physical therapy will progress to more strengthening exercises.

The best way to decrease continued pressure on the back of the head is to increase the tummy time.  For more reading on tummy time, read our blog post from Kids Place’s Teri Roberts, DPT.

Torticollis is not preventable, but it is treatable with an early referral to a Pediatric Physical Therapist and committed parents who follow the home exercise program recommended by the therapist.  Ask your pediatrician for a physical therapy evaluation if you are concerned your newborn is suffering from torticollis.



Articles referenced:

• Boere-Boonekamp M, van der Linden-Kuiper L. Postional preference: prevelance in infants and follow-up after two years. Pediatrics. 2001 Feb; 107 (2):339-43
• deChalain T, Park S. Torticollis associated with positional plagiocephally: a growing epidemic, J. Craniofac Sugery. 2005 May; 16(3): 411-8
• Do T. Congenital Muscular Torticollis: Current concepts and review of treatment. Curr Opin Pediatr. 2006 Feb; 18(1):26-9.

Part 2: Following AZOPT’s Client through Total Shoulder Replacement Surgery

Part 2: Following AZOPT’s Client through Total Shoulder Replacement Surgery

Read Part 1

In the 1950’s, shoulder replacement surgery was first performed to treat severe shoulder fractures.  Through the years, shoulder replacement surgery has been used to treat many other painful conditions in the shoulder, like arthritis.  Today, according to the Agency for Healthcare Research and Quality, approximately 53,000 people in the U.S. have shoulder replacement surgery each year.  Compared to more than 900,000 Americans who have knee and hip replacement surgery each year, shoulder replacement surgery is not as common, but still just as successful at relieving joint pain.  Just ask AZOPT patient Mr. A.

When we last left AZOPT client Mr. A, he was preparing for total shoulder replacement surgery on his left shoulder on January 10, 2013 following successful shoulder replacement surgery on his right shoulder April 26, 2012.  In fact, the success of rehabilitation on his right shoulder led him to the decision to have the surgery on the left shoulder.  The surgery of his left shoulder was performed by Dr. Jason Scalise, TheCore Institute, at Banner Thunderbird Hospital.  AZOPT’s Doug Lehman, PT, watched the entire surgery over the shoulder of Dr. Scalise.

Mr. A’s total shoulder replacement involved replacing the arthritic joint surfaces with a highly polished metal ball attached to a stem, and a plastic socket.  This was “press fit” into the bone.  To do this, Dr. Scalise saws off the humeral head (ball) and reams out the glenoid fossa (socket).  He then drills a hole into the remaining humerus bone and fits the stem of the prosthetic into the hole.  The plastic socket is screwed into what remains of the glenoid fossa.  The ball is then put back together with the socket, the range of motion is checked, and if all of the movement and alignment is positive, the incisions are sewed up and Mr. A is on his way to recovery.  The entire surgery from wheeling in to wheeling out was approximately three hours, with half of that being actual surgery time.

For the first two weeks following surgery, Mr. A kept his arm in a sling.  He performed basic exercises for the hand, wrist, and elbow along with pendulum exercises for the shoulder.  With his elbows in, Mr. A was asked to simply turn his hands from palm up to palm down, touch his fingers, and straighten then bend his elbow.  Additionally, the pendulum exercises involved allowing the surgical arm to hang loosely in a bent over position, swinging the arm gently front to back, and in circles.

01/25/2013

On January 25, 2013, two weeks after the surgery, Mr. A came to AZOPT for his initial evaluation.  Doug recorded the following active range of motion measurements:

	Right	Left (prior to surgery	Left (initial evaluation)
Flexion	140	150	92
Abduction	120	111	80
External Rotation	75	72
Internal Rotation	72	60

01/25/2013

Active range of motion means Mr. A performs these motions by himself.  Flexion is the range of motion (ROM) measurement from lifting your arm straight forward from your hip to above your head.  Abduction is the ROM measurement from lifting your arm straight from your hip out to the side and above your head.  External rotation is the ROM measurement with your elbow at 90 degree, rotating your hand outward.  Internal rotation is the ROM measurement with your elbow at 90 degrees, rotating your hand inward.  These measurements translate directly to functional activities – washing your hair, tucking in your shirt in the back, putting away dishes in the cupboard.  Generally speaking, a healthy range of motion would be 160 degrees flexion and abduction, and 90 degrees external and internal, although this does vary person to person.

Doug tells us “by observing the surgery, I was able to see the actual structures, how they were cut and reattached, and how the prosthetic pieces were attached.  Dr. Scalise guided me through the specific techniques and we discussed his rehabilitation expectations.  By learning the process and the range of motion available while Mr. A was under anesthesia, I am more comfortable aggressively obtaining range of motion and active movement early in the rehabilitation process.”

Mr. A attends physical therapy at AZOPT three times weekly.  In the first 3 weeks of physical therapy, Mr. A’s physical therapy program consisted of manual therapy focusing on improving range of motion with a slow progression of exercises and activities to regain strength and stability as his pain tolerance allowed.  According to Doug, Mr. A has responded extremely well to therapy.  Mr. A tells us his progress on his left shoulder has been quicker than his right shoulder.  With the factor of the unknown removed, Mr. A is familiar with the process and comfortable with what he needs to do to recover quickly. 

02/15/2013

On February 15, 2013, after ten physical therapy visits, Doug recorded the following active range of motion measurements:

	Right	Left (prior to surgery	Left (i.e.)	Left (02/15)
Flexion	140	150	92	135
Abduction	120	111	80	97
External Rotation	75	72		60
Internal Rotation	72	60		40

02/15/2013

A large factor to Mr. A’s recovery is his compliance with the Home Exercise Program prescribed during physical therapy.  This program ultimately gives him the greatest chance at success.  Mr. A has a pulley at home that helps with his range of motion and strength.  He also uses a golf club at home to do shoulder extensions and shoulder raises.  Furthermore, Mr. A guides a rolled up towel up and down a wall.  It is extremely important for anyone recovering from any injury to keep up with the Home Exercise Program.  Without it, physical therapy will stall and set the patient back.

 

With the addition of the Home Exercise Program, physical therapy visits continued to include progressions of manual therapy and therapeutic exercises to decrease pain and increase range of motion, strength, and stability.  After 21 visits, on March 13, 2013, Mr. A reported an overall improvement of 75% compared to his normal function.  He was still experiencing pain with activities and a decreased ability to complete normal activities of daily life that require the use of the left arm.  On this day, Doug recorded the following active range of motion measurements:

 

	Right	Left (prior to surgery	Left (i.e.)	Left (02/15)	Left (03/13)
Flexion	140	150	92	135	140
Abduction	120	111	80	97	90
External Rotation	75	72		60	67
Internal Rotation	72	60		40	62

Mr. A will continue physical therapy three times per week at this time.  He actually loves coming to AZOPT because he knows this is making him better.  While Mr. A cannot accomplish all of his goals, he realizes he is much closer.  He still cannot lift a mug of coffee, but he is able to drive again.  He also no longer experiences clicking or pain when brushing his hair.  His biggest fear before surgery was the idea of a “frozen arm” – that every time you move the arm, there’s pain, so you just don’t move it.  Through two total shoulder replacement surgeries and rehabilitation at AZOPT, Mr. A no longer has “frozen arm,” and is 75% closer to returning to normal function with no pain.

Check back with us for the third, and final, installment of Mr. A’s recovery, when Mr. A is discharged from physical therapy.

What is Sensory Integration and Why is it Important in a Child’s Development?

What is Sensory Integration and Why is it Important in a Child’s Development?

By: Liezel Fernandez, OTR/L

Pediatric Occupational Therapist at AZOPT Kids Place

Does your child have difficulty engaging in tasks?  Do they overreact to movement activities like swinging or even when their feet leave the ground? Maybe your child walks on their toes, dislikes textures or messy play, or covers their ears and negatively reacts to loud noises like a vacuum or fire alarms.  Do they refuse bathing, nail cutting, or tooth brushing?  Chew on pencils or other objects?  Does your child seek all kinds of movement, crash into walls, or lack safety awareness?  These are some of the possible signs that a child has difficulty in processing sensory information.

Sensory Processing/Sensory Integration is when our different sensory systems work together to process different sensations from our body and/or environment. When this occurs, we are able to identify and give meaning to the different sensations we experience to accomplish daily activities and move in a coordinated manner. Adversely, Sensory Processing Disorder is the inability to receive and efficiently use sensory information. Difficulty in processing sensory information interferes in our daily activities and impacts our functional ability to perform different tasks.

Our sensory systems tell us what is going on around us or in the environment. Our bodies absorb different sensory inputs, which our brain then interprets and translates. We have 7 different sensory systems that we must know: proprioception, vestibular, tactile, auditory, olfactory, oral and visual.

The Proprioceptive system (position sense) commands our body position in space, timing of movements and amount of force we are exerting during activities.  It is necessary to have a strong proprioceptive sense to develop good body awareness, motor planning and coordination.  Proprioceptive input helps calm a child, improves attention and boosts focus.  Heavy work, deep pressure and resistive activities can strengthen the proprioceptive sense.

Example of Proprioceptive activities: (Calming/Organizing)

• Deep pressure massage
• Joint compression
• Wheelbarrow walk
• Animal walks (crab walk, bear walk, seal walk, etc.)
• Chair push up
• Wall push up
• Pushing and pulling activities
• Playing tug of war
• Carrying groceries or books
• Riding a bicycle
• Swimming
• Popping bubble wraps

Our Vestibular system (movement sense) regulates tolerances to changes in movement, position in space and sense of balance.  Children with difficulties or irregularities in vestibular system are either over responsive/hypersensitive or under responsive/sensory seeker.  Vestibular input can be calming or alerting.  Slow repetitive movements tend to be calming.  Fast, jerky movements tend to be alerting.  A strong vestibular system is necessary to improve balance and postural control.

Examples of Vestibular activities:

• Swing
• Somersault
• Log rolling
• Figure eight walk
• Spinning using a swivel chair
• Bouncing or inverting on a therapy ball
• Playground slides
• Playing hopscotch or a balancing game
• Slow rocking
• Jump rope
• Jumping jacks
• Sit ups

The Tactile system (sense of touch) allows us to determine the location of touch, amount of pressure, pain and temperature.  It helps us to differentiate types of textures, size and shape of objects in the environment. Tactile system is necessary in developing fine motor skills.

Example of Tactile input/activities:

• Playing with Play doh or putty
• Sand, water, rice play
• Lotion massage
• Use of hand fidget toys
• Giving hugs
• Finger painting or messy play
• Use of vibrating toys

The Auditory system (sense of sounds) recognizes and interprets sounds in the environment and our ability to respond to it.

Examples of Auditory Input

• Listening to classical or slow music
• Use of headphones
• Singing
• Nature sounds
• Play musical instruments
• Humming
• Labeling sounds

Our Oral system processes different tastes, textures and input inside the mouth.

Examples of Oral input

• Blowing bubbles
• Use of straw when drinking
• Blowing whistles
• Exploring different taste and texture of food
• Calming:
• Sweet – lollipop, hard candy, fruits
• Chewy – bagels, gum, gummy candy
• Warm food- soup
• Alerting: Salty, crunchy, sour, spicy and cold food

Our Olfactory system processes and responds to different odors. Examples of Olfactory input

• Scented candles
• Calming scents – vanilla, lavender, sweet orange
• Alerting scents – peppermint, lemon/lime

The Visual system gives us information about what we see in the environment. Example of Visual input

• Dimming lights
• Completing puzzles, mazes, dot to dots
• Decreasing visual distractions/use of environmental modifications
• Looking at picture books
• Playing I Spy
• Putting out less toys to avoid visual overloads

If you believe that your child is experiencing any of the difficulties mentioned, then you may seek assistance from a licensed Occupational Therapist.  An Occupational Therapist will evaluate and assist in the development and/or strengthening of these areas through therapeutic interventions.

Call Kids Place at (623) 229-7808 for more information or to schedule an evaluation.

Attention Baby Boomers: Stay Healthy While Staying Fit

Attention Baby Boomers: Stay Healthy While Staying Fit

Mitch Kaye, PT,

PTPN Director of Quality Assurance

“Sixty is the new 40,” say many early baby boomers celebrating their 60th birthday this year.

This generation of 76 million people born between 1946 and 1964, determined to ward off aging, has focused more on exercise and wellness than did their parents. They were at the forefront of the aerobics and fitness movement that began in the 1970s and are now flocking to health clubs in even greater numbers.

But, as a result, increasing numbers are suffering from “Boomeritis” — the phenomenon of boomers becoming injured while exercising and playing sports at a level often too intense for their aging bodies.

Sound familiar?

It’s not just about soreness or stiffness. As boomers refuse to let injuries get in the way of their exercise routines, they’re undergoing complex knee and hip replacements and surgical repairs to the shoulder, ankle and elbow. Orthopedic surgeons say they are performing such surgeries more often on patients in their 40s and 50s than in the past.

Physical therapists are also treating more boomer patients than ever, not only for rehab after injuries and surgeries, but also for customized fitness training geared to their musculoskeletal limitations.

Staying healthy and avoiding injuries

If you’re a boomer, regular exercise is key to preventing or improving chronic conditions that come with increasing age. But you may need to make some modifications to avoid injuries.

Here are some tips for staying healthy and avoiding injury — at any age.

• Moderate cardiovascular exercise will improve the quality of your life, but be sure to get screened by a physician first.
• Exercise at a pace appropriate for your age. Adjust your activities and know that you have limitations: You may only be able to get your heart rate up so high, you may have joints that are not as flexible, or you may have arthritis.
• Seek the advice of physical therapists to work on your flexibility, strength, endurance and posture. You need to know what posture to have while sitting at a computer, as well as how to set your computer station ergonomically to reduce the risk of neck, shoulder and hand injuries.
• Stretch on a daily basis. Try to incorporate gentle stretches for your neck, back, arms and legs. Hold each stretch 15-30 seconds and do 3 repetitions each.
• Perform gradual strengthening exercises. Begin with light weights, 10 repetitions with 2-3 sets, and gradually increase the resistance.
• Eat well-balanced meals with protein at each meal, including plenty of fruits and vegetables. Drink eight glasses of water daily.
• A loss of mobility following injury, hospitalization, or even sustained sitting positions at work can speed the deterioration of muscles, joints and bone. A physical therapist can help you regain mobility and improve quality of movement.
• Exercise mentally, not just physically, by doing crossword puzzles, jigsaw puzzles, sudoku, Scrabble and other mind games.

Pregnancy and Back Pain: What You Can Do To Help

Pregnancy and Back Pain: What You Can Do To Help

By: Tyler Guymon, DPT

I am very blessed to be the father of four beautiful children.  But, as most people know, I would not have accomplished this great achievement without my wonderful wife.  Confidently I will say that while my wife would not change anything about our kids or what they have added to our family, she would happily change how she felt during the nine months prior to each of their births.  

Unfortunately, 50 to 70 percent of pregnant women experience back pain throughout their pregnancy.  While the reason for back pain varies from person to person, the majority of back pain concerns can be traced to one or more of the following factors:

• Increases in hormones
• Change’s to the body’s center of gravity
• Weight gain
• Poor posture
• Added stress

Over the last 40 years, the average age of women when they conceive their first child has risen from 21.4 to 25 years of age.  Furthermore, with women juggling the demands of pursuing a higher education and a competitive workforce, more and more women are conceiving their first child after the age of 35.  As a result, many women becoming pregnant are less physically active in their daily lives.  This decreased activity, along with the increasing national prevalence of a sedentary lifestyle, leaves an alarming number of women less prepared for the strenuous journey of carrying and delivering a baby.

You may be surprised to learn that the previously mentioned factors that cause back pain can be address by a physical therapist through a personalized program.  Through a detailed evaluation and a review of systems, a physical therapist will develop a plan of care that addresses:

• Back pain
• Decreased flexibility
• Muscle weakness
• Poor posture
• Nerve irritation/involvement
• Problems with joint alignment

Although it would be difficult to prescribe a generic exercise/stretching program that is appropriate for every woman, here are a few exercises that I feel would benefit all pregnant woman experiencing back pain:

Wall Push-Ups

Start your pregnancy exercises with wall push-ups, which work the pectoral muscles in the front of your chest and the triceps muscles in the back of your upper arm.

• Standing and facing a wall, lean forward and place your hands on the wall at shoulder height, slightly wider than shoulder-width apart.
• Keep your knees comfortably apart.  
• Slowly bend your elbows and lower your chest until your chin reaches the wall. 
• Remember to keep your back straight. 
• Then return to the starting position. 
• Gradually work up to 15 repetitions.

Squats With a Fitness Ball

Squatting during labor — even for short amounts of time — help open your pelvic outlet and allows more room for your baby to descend.  Practicing squats now will make it easier to squat during labor. Try squats with a fitness ball.

• Stand up straight with a fitness ball behind your back and against the wall, your feet about shoulder-width apart. 
• Be sure to have feet far enough from the wall that your knees do not pass the toes at the bottom of your squat.
• Slide down the wall until your knees reach a 90-degree angle, being careful to keep your heels flat on the floor. 
• Maintain upright posture - do not lean back over ball or bend forward as you descend.
• If you can't bend your knees to a 90-degree angle, simply go as low as you can — then return to the starting position. 
• Gradually work up to 10 repetitions.

Leg lifts

To strengthen your back and abdominal muscles, try leg lifts. 

• Start on your hands and knees, keeping your arms straight and your hands directly beneath your shoulders.
• Lift your right knee, straightening your leg behind you — ending with the raised leg parallel to the floor.
• Maintain level hips - do not roll to the side, and be sure to tighten
  your stomach.
• Repeat on the other side. 
• Gradually work up to 10 repetitions on both sides.

Side planks

The side plank challenges your stability and works the muscles along the side of your body.

• Lie on your left side and raise yourself onto your left forearm. 
• Place your left shoulder directly above your left elbow, keeping your shoulders, hips and knees in alignment.
• Again, do not roll to the side or lean back/forward
• Rest your right arm along the side of your body. 
• Hold for several seconds, and then lower yourself to the floor. 
• Gradually work up to 10 repetitions. 
• Repeat on the other side.

Step ups

To do a step-up, you'll need a small step stool — or you can stand in front of the stairs. 

• Position yourself near a wall or railing for extra balance or support, if needed. 
• Pushing primarily through your lead foot, lift your body up onto the step. 
• Then step backward to the starting position. 
• Alternate your lead foot each time you step up.
• Remember to keep your back straight and plant your foot entirely on the step. 
• Do as many repetitions as you can, depending on your fitness level. 
• Stop when you're fatigued or your form begins to suffer.

If you are new to exercise and fitness, or just don't know what to do, please first check with your doctor or a licensed physical therapist prior to starting an exercise program to reduce the risk of injury or increased pain.  

Call AZOPT at (623) 242-6908 to schedule an evaluation today if you feel you can benefit from a licensed physical therapist through your pregnancy.

Tips For Encouraging a Picky Toddler to Eat

Tips For Encouraging a Picky Toddler to Eat

By: Colleen Riordan, M.A., CCC-SLP

Licensed Pediatric Speech/Language Pathologist

Between the ages of 2 and 3, your child will likely go through a phase of “picky eating”.  This may range from a mild resistance to trying new foods , all the way to full-out screaming tantrums at the dinner table. While frustrating, it is important to continue to encourage your toddler to eat what the family is eating, and not give in to the temptation of offering only preferred foods.

It may help to know that  we are one of the few cultures in the world where children are routinely offered  highly processed and aggressively-marketed “kid foods”, such as chicken nuggets, macaroni and cheese,  pop tarts and tiny cheese crackers. Getting stuck in this pattern can easily turn parents into short-order cooks, preparing one meal for the children and another for the adults. It can also reinforce  food  refusals; if a child knows he will eventually get the hot dog,  there is no real motivation to try anything new and behaviors can increase.

Here are some tips for encouraging a picky toddler to eat:

• Present new foods in very small amounts to avoid overwhelming your child.
• Cut food into fun new shapes.
• Offer foods with dips your child already enjoys, such as ketchup or ranch.
• Continue to offer foods that were refused in the past; it takes multiple tastes for most people to determine if they like a new flavor.
• Present foods on divided plates or plates with fun pictures/characters under the food.
• Avoid mealtime battles by giving your child choices, both of which would be acceptable.
• Expose your child to new foods in more exciting ways:  let her help with grocery shopping, look at pictures in cookbooks, plan a meal together, visit farmers markets, plant a garden!
• Avoid “grazing” ; if your child is eating or drinking throughout the day, he is less likely to be hungry at mealtime. Adhere to a 3 meal/ 2 snack schedule.
• Eat meals together whenever possible, with your toddler remaining seated for the meal.

Check out these other helpful articles on picky-eating toddlers:

• The Mayo Clinic – Children’s Nutrition: 10 Tipsfor Picky Eaters
• Baby Center – How to Handle a Picky Eater
• NY Times – Picky Eaters?  They Get it From You

We would love to hear your feedback.  What do you do to encourage your picky eaters to try new foods?  Leave your ideas in the comment section below.

Reducing Your Risk For Type 2 Diabetes

Reducing Your Risk For Type 2 Diabetes

As our waistlines expand (the number of obese Americans has now reached more than 35%), many people are facing a higher risk of such diseases as heart disease, stroke and cancer, as well as type 2 diabetes. With the CDC reporting that more than 25 million Americans are now diabetic, and that the risk for developing diabetes is expanding across all ethnicities and age groups, it is imperative that more of us consider how to reduce our chances of developing type 2 diabetes because of obesity.

Although there is a genetic predisposition to the disease, its leading causes are often poor lifestyle choices: lack of exercise and an unhealthy diet, which can lead to being obese. Even if you have hereditary risk factors for developing type 2 diabetes, the American Diabetes Association lists several ways to reduce your chances of becoming diabetic.

Increase your physical activity.

Physical activity is imperative for your health. It keeps your heart and lungs strong, reduces stress (and weight) and improves your mood. It also reduces many of the risk factors associated with type 2 diabetes, like being overweight and having high blood pressure. If you’re trying to increase your activity levels, the ADA notes there are several things that you can do.

Move around more throughout the day. Little things can go a long way. Take the stairs instead of the elevator. Park at the far end of the lot when you run errands or go to the office. Use your break to walk a lap or two around your office building. Essentially, try to sit less; recent studies show that too much sitting can double your risk for type 2 diabetes.

Aerobic exercise. While this can be achieved by taking an aerobics or cardio class at the gym, just taking a brisk walk or bike ride can do the trick.

Strength training. Strength or resistance training has also been shown to help reduce blood glucose levels; some studies have shown that it’s even more effective than aerobic exercise. That said, many experts advise using a combination of aerobic exercise and strength training to improve health and reduce your risk of diabetes.

Flexibility and stretching. Keeping your muscles loose and flexible reduces your chance of injury, whether you’re exercising or simply moving around the house. If committing to classes like yoga or Pilates is too much, think about adding in a short stretching program before heading out for a walk.

Maintain a healthy weight.

Being overweight increases your chances of developing type 2 diabetes. If you make changes to your diet and physical activity, you may see your weight go down (and even 10-15 pounds can make a big difference in your risk). If you don’t see such positive changes, or you’re concerned that the loss isn’t enough, talk to your doctor and your physical therapist about what else you can do, and what a reasonable weight goal would be for you.

Eat healthier.

The ADA says that “eating well to maintain a healthy weight is one of the most important things you can do to lower your risk for type 2 diabetes and heart disease.” Here are some of their experts’ tips on how to improve your eating habits.

Plan smart. Make out your shopping list before going to the grocery store; it’s much easier to use willpower to avoid buying unhealthy food than it is to not eat it once it’s in the house. When thinking about what to buy, consider lean meats and fresh fruit and vegetables. If you’re not sure how much you should plan per person in your home, use the tools available at the Choose My Plate website created by the USDA. And be sure to add healthy snacks like fruit or nuts to your list; those in-between munchies (like potato chips or candy bars) can often ruin a good diet at regular meals.

Shop smart. Stock your larder with healthy basics like brown rice and whole-grain pasta, and when you run out of them, add them to your grocery list. At the store, avoid those aisles with the high-sugar, low-nutrition foods like candy and cookies in order to avoid their temptation. And try to shop when you’re not hungry; we’ve all gone to the store when we’re ravenous and ended up with things we didn’t need in the cart. (This is also why they recommend sticking to your grocery list.)

Eat smart. If you’ve bought canned vegetables, rinse them with water before cooking to reduce their sodium content. Start meals off with a salad or vegetable soup to increase your veggie intake and reduce your appetite for the (higher calorie) main course. And when you’re eating out, try to pick grilled meats rather than fried, and skip the fries for steamed vegetables.

Know your blood glucose level.

Increased blood glucose is a key indicator of type 2 diabetes. Here’s how the ADA explains its importance:

When you eat, your body breaks food down into glucose (sugar) and sends it into the bloodstream. Insulin, a hormone made by the pancreas, helps move the glucose from the blood into the cells to be used for energy. Your body usually makes just the right amount of insulin to match the food you eat.

When the cells no longer respond well to insulin, they are “insulin resistant” and glucose can’t get into the cells. So the cells don’t get the fuel they need, and glucose builds up in the blood stream. This is called high blood glucose. Untreated, high blood glucose causes problems such as nerve damage, kidney or eye problems, heart disease, and stroke.

Talk to your doctor about your glucose levels and whether they point to a risk of pre-diabetes or type 2 diabetes.

Know your cholesterol number.

Having high cholesterol can increase your chances of both type 2 diabetes and heart disease, and both can be life-threatening. If it is high, you may be able to lower it simply by eating a low-fat diet and monounsaturated fats, like olive or canola oil; others may need help with medication. Speak to your doctor about what cholesterol range is right for you, and how best to achieve it.

Know your blood pressure.

High blood pressure puts stress on your heart and on your entire body, and is another risk factor for type 2 diabetes. While increasing physical activity can help to lower it, speak to your doctor about your blood pressure and what you can do to maintain a healthy level.

The simple take-away? Eat healthy. Exercise more. It can be daunting to start new habits, but they will definitely increase your health. Look through the American Diabetes Association’s site for more tips on how to improve your habits and decrease your chances for type 2 diabetes.